Provider Demographics
NPI:1801829221
Name:KENLY DRUG & PHARMACY INC
Entity Type:Organization
Organization Name:KENLY DRUG & PHARMACY INC
Other - Org Name:KENLY DRUG & PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-284-2333
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:KENLY
Mailing Address - State:NC
Mailing Address - Zip Code:27542-0147
Mailing Address - Country:US
Mailing Address - Phone:919-284-2333
Mailing Address - Fax:
Practice Address - Street 1:104 E 2ND ST
Practice Address - Street 2:
Practice Address - City:KENLY
Practice Address - State:NC
Practice Address - Zip Code:27542-7791
Practice Address - Country:US
Practice Address - Phone:919-284-2333
Practice Address - Fax:919-284-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC081553336C0003X
NC10063183500000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0505172Medicaid
2069411OtherPK
4673310001Medicare NSC